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1、SYNTAXS Score对于无保护左主干病变冠状动脉疾病的冠状动脉介入治疗之后的用途 The SXscore has been recently developed as a combination of several previously validated angio-Graphic classifications aiming to grade the coronary anatomy with respect to the number of lesions and their functional impact, location, and complexity. Higher
2、SXscores, indicative of a more complex condition, are likely to represent a bigger therapeutic challenge and to have a potentially worse prognosis inpatients undergoing contemporary revascularization with (PCI).ClinicalPerspectiveonp308The predictive value of the SXscore was recently validated on a
3、series of patients undergoing PCI for 3-vessel coronary artery disease in the Arterial Revascularization Therapies Study Part II. However, a validation of this angiographic tool on a restricted series of patients with unprotected left main coronary artery disease undergoing PCI is lacking.We sought
4、to address this issue by applying the SXscore in patients who underwent percutaneous treatment for left main disease in our institution to examine its prognostic value in predicting in-hospital and long-term clinical outcomes. The performance of the SXscore was also explored in comparison with the m
5、odified lesion classification system of the American Heart Association/American College of Cardiology (AHA/ACC).Methods Patient PopulationAll consecutive patients undergoing PCI with either a sirolimuseluting stent (Cypher, Cordis, a Johnson and Johnson Company, Miami Lakes, Fla) or a paclitaxelelut
6、ing stent (Taxus, Boston Scientific, Natick, Mass) in left main coronary artery, from January 2003 to June 2008, at the Ferrarotto Hospital, Italy, were evaluated in this single-center study. The clinical outcome of a number of these patients was reported previously. The left main coronary artery wa
7、s defined as unprotected if there were no patent coronary artery bypass grafts to the left anterior descending artery or left circumflex artery. A percutaneous approach rather than a surgical one was performed in the presence of suitable anatomy and lesion characteristics for stenting and one of the
8、 following conditions: (1) high surgical risk defined as a European system for cardiac operative risk evaluation 46 and/or previous bypass surgery with failure of conduits; or (2) Patient refusal to undergo surgical revascularization. All patients were fully informed about the possible procedure-rel
9、ated risks and the alternative treatment options, and written informed consent was obtained from all patients.Stent implantation was performed according to standard techniques, and the final interventional strategy was left entirely to the operators discretion. The use of intravascular ultrasound wa
10、s used at the operators discretion. Lesions located at the ostium or shaft were treated with a single stent. Bifurcation lesions were treated by using one of the following strategies at the operators discretion: provisional T-stenting, T-stenting, V-stenting, or mini-crush stenting.Interventional st
11、rategy and administration of glycoprotein IIb/III a inhibitors were left to the discretion of the operators. Glycoproteins IIb/III were used in 36.7% of patients. An intravenous bolus of unfractioned heparin was administered at a dose of 70 units /kg immediately before PCI, and an additional bolus w
12、as given to achieve a target activated clotting time between 250 and 300 seconds. In case of abciximab administration, the loading dose of unfractioned heparin was 50units/Kg, and the target activated clotting time was 250 seconds.All patients were on aspirin (100mg per day) that was continued indef
13、initely. A loading dose of 300 to 600 mg of clopidogrel was given the day before PCI elective procedures or in the catheterization laboratory in emergent revascularizations and followed by 75mg daily for 12 months. Alternatively, ticlopidine, at a dose of 250mg twice daily, was given for 4 (1.5%) of
14、 259 patients included in this registry, the diagnostic angiogram was not available or was of poor imaging quality. Thus, 255 patients were included in this analysis. SXscore CalculationThe total SXscore was derived from the summation of the individual scorings for each separate lesion(defined as 50
15、% stenosis in vessel 11.5 mm). Full details on SXscore calculation were reported elsewhere. All angiographic variables pertinent to SXscore calculation were computed by 2 of 3 experienced cardiologists who were blinded to procedural data and clinical outcome on angiograms obtained before the procedu
16、re. In case of disagreement, the opinion of the third observer was obtained, and the final decision was made by consensus. SYNTAXS Score对于无保护左主干病变的冠状动脉介入治疗之后的用途SXscore的最近发展成为几个先前确认为有效的血管造影的分类的结合体，旨在对冠状动脉解剖就病灶的数量及其功能的影响,位置,和复杂性进行分级。高等SXscores,更为复杂,可能会提出一个更大的治疗挑战，同时也可能存在经过血管冠状动脉介入治疗患者潜在预后差的情况。从临床的角度来看待p308SXscore的预测值在动脉血管成形术治疗研究的第二部分中对于一些3支冠状动脉疾病患者身上进行了验证。然而, 对于这一血管造影的工具在经过冠状动脉介入治疗之后的无保护左主干病变患者上的验证仍为空白。我们试图通过把S
